Common uses

Lariam is indicated for the treatment of mild to moderate acute malaria caused by Mefloquineuine-susceptible strains of P. falciparum (both chloroquine-susceptible and resistant strains) or by Plasmodium vivax. There are insufficient clinical data to document the effect of Mefloquineuine in malaria caused by P. ovale or P. malariae.

Before using

Do not take mefloquine without first talking to your doctor if you have a history of depression, an anxiety disorder, psychosis, schizophrenia, another major psychiatric disorder, or seizures.
Before taking mefloquine, tell your doctor if you have
• liver disease;
• an irregular heartbeat or heart disease; or
• an allergy to quinine or quinidine.
You may not be able to take mefloquine, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.
Mefloquine is in the FDA pregnancy category C. This means that it is not known whether it will be harmful to an unborn baby. Animal studies have shown that it may be dangerous. It is recommended that a reliable birth control be used during treatment with mefloquine. Do not take this medication without first talking to your doctor if you are pregnant or could become pregnant during treatment. Mefloquine passes into breast milk and may affect a nursing baby. Do not take mefloquine without first talking to your doctor if you are breast-feeding a baby.

Directions

Obtain a Medication Guide that must be provided by your pharmacist. Read the Medication Guide before you first start taking lariam and each time you obtain a refill. If you have any questions, regarding the information, ask your doctor or pharmacist. Carry the information wallet card with you at all times. Take by mouth, usually once a week, with food or milk to prevent stomach upset; or as directed by your doctor. Also take with a full glass (8 oz. or 240 ml) of water. Do not take this on an empty stomach. For children who cannot swallow the tablets whole, lariam may be crushed and placed in a small amount of water, milk or sugar water. It should be given with food and should not be taken on an empty stomach. The doctor will tell you the correct dose to use for your child. The dose is based on your child's weight. For children, early vomiting may occur after taking lariam. If vomiting occurs in your child within 30 minutes of taking the drug, give another full dose. If vomiting occurs 30 minutes to 1 hour after a dose, give a half-dose. If vomiting continues, check with your doctor for a different medication to use in place of lariam. When using to prevent malaria, the first dose of this medication should be taken one week before travel, or as directed by your doctor. Take this medication as prescribed for full course of treatment. It is important you not miss any doses and that you take the drug on a regularly scheduled basis. Remember to take it on the same day each week. Upon returning from a malaria area, you should keep taking this medication for 4 more weeks. If you are unable to finish this course of mefloquine, contact your doctor. If this medication is being used for prevention of malaria, it is important to understand that it is still possible to contract the disease. Notify your doctor immediately if you develop a fever. Malaria is best treated if therapy is started early.

Cautions

Mefloquine may cause psychiatric symptoms in a number of patients, ranging from anxiety, paranoia, and depression to hallucinations and psychotic behavior. On occasions, these symptoms have been reported to continue long after Mefloquineuine has been stopped. Rare cases of suicidal ideation and suicide have been reported though no relationship to drug administration has been confirmed. To minimize the chances of these adverse events, Mefloquineuine should not be taken for prophylaxis in patients with active depression or with a recent history of depression, generalized anxiety disorder, psychosis, or schizophrenia or other major psychiatric disorders. Lariam should be used with caution in patients with a previous history of depression.
During prophylactic use, if psychiatric symptoms such as acute anxiety, depression, restlessness or confusion occur, these may be considered prodromal to a more serious event. In these cases, the drug must be discontinued and an alternative medication should be substituted.

Possible side effects

In some cases, serious mental side effects have occurred in people taking mefloquine. Stop taking mefloquine and seek medical attention immediately if unexplained signs of anxiety, depression, restlessness, feelings that people are against you, hallucinations (seeing or hearing things that are not there, for example), psychotic behavior, thoughts of suicide, or confusion occur. However, it is important to continue to take a medicine for protection from malaria when traveling to a malaria area. A healthcare provider may need to prescribe a different medication.
Mefloquine may affect your liver and your eyes if you take it for a long time. Ask your healthcare provider to tell you if you should have your eyes and liver checked while taking mefloquine.
If you experience any of the following serious side effects, seek emergency medical attention:
• an allergic reaction (swelling of the lips, face, or tongue; shortness of breath; difficulty breathing; or closing of the throat);
• seizures; or
• irregular heartbeats.
Other, less serious side effects may be more likely to occur. Continue to take mefloquine and talk to your doctor if you experience
• nausea, vomiting, diarrhea, or loss of appetite;
• chills or fever;
• muscle aches or weakness;
• ringing in the ears;
• a rash or itching;
• blurred vision;
• insomnia or abnormal dreams;
• headache; or
• dizziness or drowsiness.
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

If you take too much

Seek emergency medical attention if an overdose is suspected.
Symptoms of a mefloquine overdose may be similar to side effects of the medication, although often more severe.

Additional information

If you get a fever during or after you start taking mefloquine, do not treat yourself. Contact your healthcare provider immediately.

If you are taking mefloquine or have taken mefloquine in the past 3 weeks, you should not take halofantrine (another malarial drug). Dangerous heart side effects may occur. Talk to your health care provider.

Tell your prescriber or health care professional if your symptoms do not improve in a few days. If you are taking mefloquine for a long time, visit your prescriber or health care professional for regular checks. If you notice any changes in your vision see your ophthalmologist for an eye exam.

Drug interactions

Do not take mefloquine with any of the following medications without first talking to your doctor:
• a heart medicine in the class called beta-blockers, such as propranolol (Inderal), metoprolol (Lopressor), acebutolol (Sectral), betaxolol (Kerlone), carteolol (Cartrol), carvedilol (Coreg), labetalol (Normodyne, Trandate), nadolol (Corgard), pindolol (Visken), timolol (Blocadren), and others;
• any medicine used to treat seizures;
• chloroquine (Aralen); or
• quinidine (Cardioquin, Quinaglute, Quinora, Quinidex) or quinine (Quinamm).
Taking mefloquine may be dangerous if you are taking any of the medications listed above.
Immunizations that use live attenuated (weakened) strains of bacteria should be completed at least 3 days before the first dose of mefloquine to ensure an adequate effect of the immunization.
Drugs other than those listed here may also interact with mefloquine. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including vitamins, minerals, and herbal products.